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Most side effects subside with time; decreased liver function may occur with high doses. Taking aspirin or NSAID 30 min before drug may prevent flushing; take drug with food. Treat elevated homocysteine levels with folic acid.

May ↑ effects of warfarin (Coumadin) and some antihyperglycemic drugs. When used in combination with statins, may increase adverse effects of statins, especially myopathy.

Bile-Acid Sequestrants Mechanism of Action and Effects

Bind with bile acids in intestine, forming insoluble complex and excreted in feces, resulting in removal of LDL and cholesterol; ↓ LDL

Bile-Acid Sequestrants Nursing Considerations

Effective and safe for long-term use; side effects diminish with time. Interfere with absorption of many drugs (e.g., digoxin, thiazide diuretics, warfarin, some antibiotics [e.g., penicillins]).

Cholesterol Absorption Inhibitor Mechanism of Action and Effects

Inhibits the intestinal absorption of cholesterol; ↓ LDL; ↑ HDL

Cholesterol Absorption Inhibitor Nursing Considerations

When used with a statin, LDL is further reduced. Should not be used by patients with liver impairment.

Simvastatin (Zocor) Drug Alert

Increased risk for rhabdomyolysis when also used with gemfibrozil (Lopid) or niacin. Signs of rhabdomyolysis: ↑ creatine kinase levels, muscle tenderness.

Niacin (Niaspan) Drug Alert

Instruct patient that flushing (especially of face and neck) may occur within 20 minutes after taking drug and may last for 30 to 60 minutes. Can premedicate with aspirin or NSAID 30 minutes before to reduce flushing.

Gemfibrozil (Lopid) Drug Alert

May increase the risk of bleeding in patients taking warfarin (Coumadin). May increase the effects of antihyperglycemic drugs (e.g., repaglinide [Prandin]).

Tablet or spray needs to be administered under the tongue. Instruct patient not to combine with drugs used for erectile dysfunction (e.g., sildenafil [Viagra]). Monitor for orthostatic hypotension because it may occur after administration.

fibrinolytic therapy; used in ST-segement-elevation MI (STEMI) to break up fibrin meshwork in clots

TNK-tPA (tenecteplase [TNKase]) classification and use

fibrinolytic therapy; used in ST-segement-elevation MI (STEMI) to break up fibrin meshwork in clots

Fibrinolytic Drug Alert

If signs and symptoms of major bleeding occur (e.g., drop in BP, an increase in HR, a sudden change in the patient's level of consciousness, blood in the urine or stool), stop the therapy and notify the physician.